POS1188-HPR EXPERIENCES OF TELEMONITORING PULMONARY FUNCTION IN SYSTEMIC SCLEROSIS ASSOCIATED INTERSTITIAL LUNG DISEASE – A QUALITATIVE STUDY
Authors: A. Velauthapillai, G. Schepers, M. Vonk, C. Van den Ende
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Systemic sclerosis (SSc) is a heterogeneous auto-immune disease with interstitial lung disease (ILD) being the leading cause of mortality [1]. Current practice is to treat patients with severe or progressive ILD with immunosuppression[2]. Therefore tight monitoring of the pulmonary function is of huge importance, which can be improved by telemonitoring. <h3>Objectives</h3> To analyse experiences, facilitators and barriers of telemonitoring the pulmonary function in SSc-ILD patients. <h3>Methods</h3> This study was embedded in a longitudinal study on the validity of detecting progressive ILD with weekly home spirometry in adult SSc patients, fulfilling the ACR-EULAR criteria with a disease-duration ≤ 5 years and a maximum of immunosuppressive treatment of 8 weeks. Using a bluetooth-enabled handheld spirometer, measurements are collected via a mobile application for smart devices with results being visible, as graphs and bar charts, for both physician and patient. The weekly measurements are evaluated by a physician and an extra hospital check-up will be scheduled if results decrease. This system has proven to be feasible in SSc patients in our pilot study [3]. In patients, who used home spirometry for at least 3 months, semi-structured interviews were conducted and audio-records were transcribed. Patients were selected using purposive sampling based on age, treatment for ILD and course of pulmonary function in telemonitoring (&gt;5% decline/stable) till data-saturation was achieved (i.e. no new codes in the last 2 interviews). Interviews were coded by 2 researchers independently using inductive thematic analysis. <h3>Results</h3> In total 13 patients (8 female/5male) were interviewed from whom 3 patients had &gt; 5% decrease in pulmonary function during the observation period. The age ranged from 36-75 with a median of 58 year. Five main themes were extracted: telemonitoring routine, impact of telemonitoring, trust in telemonitoring, contextual factors and implementation in regular healthcare (Figure 1). Most patients perceived it as reassuring to see stable results weekly, though the moment itself might be tensive. Moreover, the possibility to detect progressive disease earlier was appreciated. One patient, however, preferred disease activity being monitored by the physician instead. Some patients placed fluctuations of measurement within limits of normal in perspective, while others experienced negative feelings in case of a decreased value. Experienced advantages of telemonitoring were being in the lead, insight in disease course (for some resulting in less confronting hospital visit), increased trust in health, decreased fear of progression, and reduced dependence on hospital visits. Most patients trusted the results of telemonitoring, although some trusted the hospital measurements more, because of external guidance from an analyst (leading to more motivation and unbiased results), and the manner of measurement (during breathing cycle in hospital vs. single breath at home). Understanding the rationale behind telemonitoring is an important facilitator, whereas possible barriers to perform weekly home spirometry are excessive saliva production (as it hinders proper function of the spirometer), confrontation with the disease, and older age. Most patients advocated to implement telemonitoring in healthcare and appreciated an accompanied reduction in hospital visits, although others viewed the regular physical contacts and control of other disease features as important. It was recommended to provide information about limits of normal values or regular feedback. <h3>Conclusion</h3> In SSc telemonitoring the pulmonary function can contribute to patient empowerment, however it might not be suitable for every patients, as it might elicit negative feelings. <h3>References</h3> [1] Elhai M et al., Ann Rheum Dis. 2017;76(11):1897-905. [2] Kowal-Bielecka O et al, Ann Rheum Dis. 2017;76(8):1327-39. [3] Moor CC et al, Rheumatology (Oxford). 2021;60(5):2467-71. <h3>Acknowledgements</h3> I have no acknowledgements to declare. <h3>Disclosure of Interests</h3> Arthiha Velauthapillai: None declared, Gwyn Schepers: None declared, Madelon Vonk Speakers bureau: Boehringer Ingelheim, Bristol-Myers Squibb, GSK, Janssen, MSD, Novartis and Roche, Consultant of: Boehringer Ingelheim and Janssen, Grant/research support from: Research grants from Boehringer Ingelheim, Janssen,Ferrer and Galapagos, Cornelia van den Ende: None declared.